When they know they're "going to the doctor," many kids worry a bit about the visit. Whether they're going to see their primary care doctor or a specialist for a routine exam, illness, or special problem, kids are likely to have fears, and some may even feel guilty.

Some fears and guilty feelings surface easily, so that kids can talk about them. Others are kept secret and remain unspoken. Here's how to help your child express these fears and overcome them.

Common Fears and Concerns About Medical Exams

Things that often top kids' lists of concerns about going to the doctor include:

Separation. Kids often fear that their parents may leave them in the exam room and wait in another room. The fear of separation from the parent during mysterious examinations is most common in kids under 7 years old, but can be frightening to older kids through ages 12 or 13.

Pain. Kids may worry that a part of the exam or a medical procedure will hurt. They especially fear they may need an injection, particularly kids ages 6 through 12.

The doctor. Some kids' concerns may be about the doctor's manner. A kid may misinterpret qualities such as speed, efficiency, or a detached attitude and view them as sternness, dislike, or rejection.

The unknown. Kids sometimes worry that a medical problem is much worse than their parents are telling them. Some who have simple problems suspect they may need surgery or hospitalization; some who are ill worry that they may die.

Also, kids often have feelings of guilt: They may believe that their illness or condition is punishment for something they've done or neglected to do. Kids who feel guilty also might believe that examinations and medical procedures are part of their punishment.

How to Help

Encourage your kids to express their fears, and then address them in words that they understand and aren't likely to misinterpret. Here are some practical ways to do this:

Explain the Purpose of the Visit

If the upcoming appointment is for a regular health checkup, explain that it's "a well-child visit. The doctor will check on how you're growing and developing, and also ask questions and examine you to make sure that your body is healthy. And you'll get a chance to ask any questions you want to about your body and your health." Also, stress that all healthy kids go to the doctor for such visits.

If the visit is to diagnose and treat an illness or other condition, explain — in very non-scary language — that the doctor "needs to examine you to find out how to fix this and help you get better."

It's wise to prepare kids by giving them advance notice of a visit so it's not a surprise. When explaining the purpose of the visit, talk about the doctor in a positive way to help promote the relationship between your child and the doctor.

Address Any Guilty Feelings

A child who is going to the doctor because of an illness or other condition might have unspoken feelings of guilt about it. Discuss the illness or condition in neutral language and reassure your child: "This isn't caused by anything you did or forgot to do. Illnesses like this happen to many kids. Aren't we lucky to have doctors who can find the causes and who know how to help us get well?"

If you, your spouse, other relatives, or friends had (or have) the same condition, share this information. Knowing that others have been through the same thing can help ease a child's guilt and fear.

If your child needs a doctor's attention because of a condition that resulted in ridicule or rejection by other kids (or even by adults), you'll need to double your efforts to relieve shame and blame. Head lice, embarrassing scratching caused by pinworm, and involuntary daytime wetting or bedwetting are examples of conditions that are often misunderstood by others.

Even if you've been very supportive, reassure your child again, before the visit to the doctor, that the condition is not his or her fault and that many kids have had it.

Of course, if your child has suffered an injury after disregarding safety rules, it's wise to point out (as matter-of-factly as possible) the cause-and-effect relationship between the action and the injury. However, you should still try to relieve guilt. You could say, "You probably didn't understand the danger involved in doing that, but I'm sure you understand now, and I know you won't do it that way again."

In any of these cases, though, be sure to explain, especially to young kids, that going to the doctor for an examination is not a punishment. Help your kids understand that adults go to doctors just like kids do and that the doctor's job is to help people stay healthy and fix any problems.

Tell Kids What to Expect During a Routine Exam

Children learn best during play, and this may be a time when they feel most comfortable asking any questions regarding fears they may have. You can use a doll or teddy bear to show a young child how the nurse will measure height and weight or demonstrate parts of the routine exam.

Many children's books are available to help illustrate the doctor visit. It also helps to use role-playing to show how the doctor might:

use a blood pressure cuff to "hug the arm"

look in the mouth (and will need to hold the tongue down with a special stick for just a few seconds to see the throat)

look at the eyes and into the ears

listen to the chest and back with a stethoscope

tap or press on the tummy to listen to or feel what's inside

look quickly to see that the "private areas" are healthy

tap on the knees

look at the feet

It's important for parents to let their kids know that what they've taught them about the privacy of their bodies is still true, but that doctors, nurses, and parents must sometimes examine all parts of the body. Emphasize, though, that these people are the only exceptions. And reassure your child that you will be in the exam room with him or her.

Tell Kids What to Expect During Other Exams

If your child is going to the doctor because of an illness or medical condition or is going to visit a specialist, you might not even know what to expect during the exam.

When you're calling to make the appointment, you can ask to speak to the doctor or a nurse to find out, in a general way, what will take place during the office visit and exam. Then you can explain some of the procedures and their purpose in gentle language, appropriate to your child's age level. Your child will feel more secure understanding what's going to take place and why it's necessary.

Be honest, but not brutally honest. Let your child know if a procedure is going to be somewhat embarrassing, uncomfortable, or even painful, but don't go into alarming detail.

Reassure your child that you'll be there and that the procedure is truly necessary to fix — or find out how to fix — the problem. (Adolescents may prefer to be examined without a parent or with only a same-sex parent or same-sex chaperone present. That preference should be honored.)

Kids can cope with discomfort or pain more easily if they're forewarned, and they'll learn to trust you if you're honest with them. If you don't know much about the illness or condition, admit that but reassure your child that you'll both be able to ask the doctor questions about it. Write down your child's questions.

If a blood sample will be taken during or after the examination, be careful how you explain this. Some young kids worry that "taking blood" means that all their blood will be taken. Let your child know that the body contains a great deal of blood and that only a very little bit of it (usually no more than 1 or 2 teaspoons [about 10 milliliters]) will be taken for testing.

Again, make certain that your child understands that the visit, with its embarrassing or uncomfortable procedures, is not a punishment for any misbehavior or disobedience.

Involve Your Child in the Process

Gathering information for the doctor. If the situation isn't an emergency, let your child contribute to a list of symptoms that you create for the doctor. Include all symptoms you've observed, no matter how unrelated they may seem to the problem at hand. Also, before the visit, prepare a list of your child's previous illnesses and medical conditions and a history of illnesses and medical conditions among close members of the family (parents, siblings, grandparents, aunts, and uncles).

Writing down questions. Ask your child to think of questions to ask the doctor. Write them down and give them to the doctor. Or, if kids are old enough, they can write down and ask the questions themselves. If the problem has happened before, list the things that have worked and the things that haven't worked in previous treatment. Kids will be reassured by your active role in their medical care and will learn from your example. And you'll be prepared to give the doctor information vital to making an informed diagnosis.

Choose a Doctor Who Relates Well to Kids

Because your doctor is your best ally in helping your kids cope with health examinations, it's important to carefully select a doctor. Of course, you want one who's knowledgeable and competent. However, you also want a doctor who understands kids' needs and fears and who communicates easily with them in a friendly manner, without talking down to them.

In the course of a physical exam, the doctor inspects, taps, and probes various parts of the body — procedures that may be embarrassing (or even physically uncomfortable) for kids. A good relationship between doctor and patient can minimize these feelings.

If your child's doctor seems critical, uncommunicative, disinterested, or unsympathetic, do not be afraid to change doctors. Ask for recommendations from other parents in your area or from other doctors whose opinions you trust.

If your child's illness or condition requires a specialist, ask your doctor to recommend someone who's knowledgeable, experienced, and friendly. After all, adults want these characteristics in their own doctors, so as a parent you should be your child's advocate in seeking medical care.